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General NPI Number Information
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NPI Number | 1609200914
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Entity Type | Individual
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Provider Name | NANCY DYKSTRA-POWERS LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 71 FRANKLIN TPKE STE 4
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City | WALDWICK
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State | NJ
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Zip | 07463-1851
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Country | US
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Telephone | 201-321-5610
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Fax | 972-423-9379
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Provider Business Mailing Address
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Address Line | 71 FRANKLIN TPKE STE 4
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City | WALDWICK
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State | NJ
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Zip | 07463-1851
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Country | US
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Telephone | 201-321-5610
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Fax | 973-423-9379
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC00273700
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License Number State | NJ
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